Practically Unheard Of Home Health Care Benefits - Part I

If I were the new publisher of a national newspaper, the above headline would be my first issue's headline. It's time for hush hush government programs to come clean. It's time to tell the general public the information they need to know in order to receive federal health benefits that they qualify for and are seldom told about.

Shocking Numbers!

Out of eleven million, four hundred thousand eligible households, only 520,000 are currently receiving up to $1,843 a month in additional income for their long term health care needs. Explained in other simple mathematical terms, this means:

• 33% of all seniors in the country are eligible for this benefit.
• Only 4.6% of eligible seniors are actually receiving these benefits.
• At minimum 2,500,000 people should be receiving this benefit.
• This is five times the number of eligible households than those who receive the benefit now.

The amazing facts:

• Up to $1,843 a month in additional income is available for qualifying individuals to cover their long term in-home health care costs.
• Households earning over $3,000 a month and up can qualify for this pension, once allowable deductions are made from qualifying income.
• This pension is a benefit paid to wartime veterans who have limited or no income.
• It applies to veterans who are over 65
• It applies to veterans who are under 65 and totally disabled
• Veterans who are more seriously disabled may qualify for additional Aid and Attendance benefits.
• Veterans who are more seriously disabled may qualify for Housebound benefits.
• Aid and Attendance or Housebound benefits are paid in addition to the basic pension rate.
• This benefit applies to qualifying veteran's widows and widowers

The program is called the "VA Pension" and sometimes is referred to as "Aid and Attendance Benefit. " Additionally, not all of the eligible recipients for this program are elderly. Even if you've heard about the program, you may only know the basic facts that:

• It will cover the costs of assisted living.
• In some cases, it will cover nursing home care.

However, even those who have heard of the program, don't know:

• The program can be used for home health care.
• The benefit will pay anyone, including your child, friends, and other relatives, to care for you or your spouse in your own home.

In order to qualify for the VA Pension for Veterans, you or your deceased spouse, had to have been a wartime veteran. There are a lot of misconceptions about this:

• Many former military think because they didn't actually leave the United States during their time of service, that they don't qualify. Wrong!
• Many veterans think that just because the military didn't tell them about this benefit when they were discharged, that they don't qualify. Wrong!
• Many veterans are simply unaware of the actual dates of qualification and therefore, think this doesn't apply to them. Also faulty thinking.
• Many veterans think that just because they are on Medicare, they don't qualify. Wrong!
• Many former military think they must be disabled to qualify. Also wrong!
• Many think they must be a senior citizen to qualify. Definitely wrong!
• Others assume just because they were discharged prior to their full term of enlistment, that they do not qualify. Also faulty thinking.
• Still others assume that because they weren't wounded in battle or that their disability wasn't military connected, that they don't qualify. Very wrong!

Time of service dates for eligible veterans are:

• World War II. December 7, 1941, through December 31, 1946, inclusive. If the veteran was in service on December 31, 1946, continuous service before July 26, 1947, is also considered World War II service.
• Korean Conflict. June 27, 1950, through January 31, 1955, inclusive.
• Vietnam Era. The period beginning on February 28, 1961, and ending on May 7, 1975, inclusive, in the case of a veteran who served in the Republic of Vietnam during that period. The period beginning on August 5, 1964, and ending on May 7, 1975, inclusive, in all other cases.
• Persian Gulf War. August 2, 1990, through date to be prescribed by Presidential proclamation or law.

Prior to application, you first need to understand how the VA determines your eligibility. Furthermore, because the application process is both complex and detailed oriented -- there is some basic terminology you will need to learn first:

1. The VA uses a term -- countable income-- which means this determination will include earnings, disability and retirement payments, interest and dividends, and net income from farming or a business. It also includes a presumption, that all of an adult child's income is available to, or for the veteran. (Something you will possibly need to disprove, if it applies in your case).
2. The Va uses a term - exclusions -- meaning however, the VA may grant an exception to the above, in hardship cases.
3. It also uses the term -- net worth -- which means the net value of the assets of the veteran and his or her dependents. This includes such assets as bank accounts, stocks, bonds, mutual funds and any property other than the veteran's residence and a reasonable lot area. There is no set limit on how much net worth a veteran and his dependents can have, but net worth cannot be excessive. The decision as to whether a claimant's net worth is excessive, depends on the facts of each individual case.
4. It also uses the term -- MAPR - which means the Maximum Allowable Pension Rate. What does all of this work out to? Simply that, the veteran household cannot have income exceeding the Maximum Allowable Pension Rate. (See MAPR rates caption bullet below). Remember that this MAPR is the income after factoring in certain deductions.

What income is not included:

• Public assistance, such as Supplemental Social Security income;
• Other sources of income;
• Part of any non-reimbursed medical expenses paid by the veteran after the VA receives the veteran's pension claim may be deducted. NOTE: These are expenses, that you won't get get reimbursed for via Medicaid or medical insurance);
• Education expenses;
• Education expenses of dependent children.

It is key to understand the VA's rating system for "aid and attendance" or "housebound" categories. The rating system allows the VA to pay additional benefits beyond the regular benefit cap, in order to help cover the additional costs associated with added disabilities.

Determination factors:

• A rating for these allowances is determined by a veteran service representative who has been trained to recognize from medical reports and interviews whether the veteran or his surviving spouse needs the additional care.
• Determinations of a need for aid and attendance or housebound benefits may be based on medical reports and findings by private physicians or from hospital facilities.
• Authorization of aid and attendance benefits without a rating decision, is automatic if evidence establishes the claimant is a patient in a nursing home.
• Aid and attendance is also automatic if the claimant is blind or nearly blind or having severe visual problems.

Additional determination criteria:

• Inability of claimant to dress or undress himself (herself), or to keep himself (herself) clean;
• Frequent need of adjustment of any special prosthetic or orthopedic appliances without help;
• Inability of claimant to feed himself (herself) through loss of coordination of upper extremities or through extreme weakness;
• Inability to go to the bathroom by without aid;
• Incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment.

A special provision for calculating pension income, allows household income to be reduced by 12 months worth of future, recurring medical expenses. Normally, income is only reduced by medical expenses incurred in the month of application.

These allowable, annualized medical expenses are such things as insurance premiums, the cost of home care, the cost of paying any person to provide care, the cost of adult day care, the cost of assisted living and the cost of a nursing home facility. In most cases, these expenses are only deductible if there is a rating.

This special provision can allow veteran households earning more than the annual MAPR to qualify for pension. As an example, a veteran household earning $6,000 a month could still qualify for pension if the veteran is paying $4,500 to $6,000 a month for nursing home costs. The applicant must submit appropriate evidence for a rating and for recurring costs in order to qualify for this special provision.

NOTE: The VA normally does not tell applicants about this special treatment of medical expenses or how to qualify for it.

The care arrangements and payment for home care must be made prior to application.

• There must be medical evidence that this care is needed on an ongoing and regular basis.
• A formal written contract needs to be made.
• Weekly billing for services must be done by the provider.
• Money must exchange hands and their must be evidence of this.
• Costs for these services must be non-reimbursed -- meaning these costs are not paid by or covered by insurance or contributions by family or other sources.

NOTE: All documentation must be provided as proof to the VA at the time of application for the pension benefit.

There is also an asset test to qualify for this pension. Here are the facts:

• Any asset or investment that could be easily converted into income might disqualify the claimant.
• An asset ceiling of $80,000 is often cited in the media as being the test. The $80,000 has to do with VA internal filing requirements and is not an actual test. In reality, there is no dollar amount for the test, and any level of assets could block the award.
• The asset test ultimately becomes a subjective decision made by the veterans service representative, processing the application.

NOTE: Some attorneys recommend using a qualified aid and attendance benefit legal advisor when dealing with assets that may disqualify. It is extremely important that assets that might be gifted or converted to income also meet Medicaid gifting rules, in case the veteran or the surviving spouse may have to apply for Medicaid. The consulting legal advisor can help avoid Medicaid penalties associated with reallocating assets.

• Learn how to apply for Aid and Attendance
• Discover Eligible Designations
• The Rules for Non-licensed In-home Attendant
• All About Long Term Special Care Cases
• When You Need Outside Help to Claim This Benefit

and more.........